By Lisa Rapaport

People who are overweight or obese may get more physical activity when they participate in step-counting contests than when they simply use activity trackers to monitor their own steps, a recent experiment suggests.

Researchers asked 602 overweight and obese adults to wear step trackers and set goals to increase their daily steps. Then researchers sorted participants into four groups: one that only counted steps, and three different groups that also had games designed to inspire more movement through encouragement, prizes or competition.

The games lasted 24 weeks. By the end, all three of the games-based groups increased step counts by more than the control group of people simply tracking their own movements.

After another 12 weeks went by, however, only the people who competed against each other continued to log increases in their daily steps, researchers reported September 9 online in JAMA Internal Medicine.

“We found that participants were motivated the most by competition and it encouraged them to create habits that stayed in place once the game was over,” said Dr. Mitesh Patel, lead author of the study and director of the Penn Medicine Nudge Unit at the University of Pennsylvania in Philadelphia.

Over the entire nine-month study period, the average person assigned to do step-counting games with competition walked about 100 miles more than the average person in the control group, Patel said by email.

Participants were 39 years old on average and typically obese, with an average body mass index (BMI) of 30. At the start of the study they logged an average of 6,100 to 6,300 steps a day.

When the study started, researchers asked each participant to set their own goals for increasing their daily steps. People could choose to boost their step counts by 33%, 40%, 50%, or by at least 1,500 steps.

Setting goals in advance can help people stick to them, Patel said.

People in the games groups also got awarded 70 points at the start of each week, and kept or lost 10 points for each day that they hit or missed daily step targets. In addition, people in the games groups could move up or down levels within the games based on their performance each week.

By the end of the 24-week intervention, people who did games based on competition logged an average of 920 daily steps more than the control group that only counted steps, while games with encouragement from family or friends were associated with 689 more daily steps and games with team collaboration to win prizes were tied to 637 more daily steps.

After another 12 weeks without any games, people in the competition group still logged an average of 569 more daily steps than participants in the control group that only counted steps.

The study didn’t look at whether any added daily steps resulted in weight loss or other health benefits for the participants.

Still, the results suggest there are ways to get moving that may be more effective than simply wearing a step tracker, Patel said.

“Exercising with a friend or partner is definitely more effective for sticking to a goal compared to doing it on your own,” said Dr. Ichiro Kawachi, a researcher at the Harvard T.H. Chan School of Public Health in Boston who wasn’t involved in the study.

“If you’re a very organized person, you could even start a team competition in your own workplace to encourage everyone to get off the couch,” Kawachi said by email.

Games can work even when people don’t know their competitors, said Dr. David Geier, orthopedic surgeon and sports medicine specialist in Charleston, South Carolina, who wasn’t involved in the study.

“Competition with someone else, even if you don’t know that person, can increase your activity level,” Geier said by email. “There are also smartphone apps with gamification tools that allow you to compete for prizes and even money.”


JAMA Intern Med 2019.